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1. FACTORS AFFECTING THE UTILIZATION OF
ANTENATAL CARE SERVICES BY
THE PREGNANT WOMEN IN
DISTRICT UMERKOT
Proposal Submitted to: DR. SUMEERA RIZVI
By: Dr. Monika Maheshwari
36-II-B; Spring Semester
MSPH- SZABIST

2. INTRODUCTION
• Pregnancy and childbirth and their related complications stand as the primary cause of mortality
and disability among women in their reproductive years in developing countries
• The key objectives of the Sustainable Development Goals (SDGs) for 2015 was to improve
maternal health
• 5,92,000 in 2005 while 295,000 maternal deaths in year 2017 worldwide (800 mothers lost/ day)
• MMR in Pakistan still higher i.e. 178 per 100,000 live births (Target was 140 by 2015)
• Timely antenatal care is crucial for enhancing the health of both the mother and new-born

3. INTRODUCTION
• Antenatal care can be defined as the care provided by skilled health-care professionals to pregnant
women
• Insufficient access and underutilization of ANC is major hurdle to achieve optimum maternal health
outcomes
• Globally, only 64% women receive ANC at least four times during pregnancy (WHO recommend)
• In low-income countries, only 40% of pregnant women receive ANC at least four times in pregnancy
• Nations like India, China, Ethiopia, and Cambodia has much improved ANC coverage (89-95%)
• However; rural areas of these countries have lower ANC coverage (53-92%)

4. INTRODUCTION
• 47% of pregnant women in Pakistan receive WHO recommended 4 ANC (PDHS-2018)
• 40% rural areas while 62% in urban areas (PDHS-2018)
• Factors affecting ANC utilization may include education, poverty, income, housing, cultural
taboos, residence, Pakka house, electricity in house, high transport costs, cultural/ caste taboos,
restriction from husband or mother-in-law
• Other factors may include previous experience of ANC, attendants lack of awareness, higher birth
orders, deficiency of facility resources, indifferent attitude and non-availability of the staff (PDHS-
2018 and other studies)

5. JUSTIFICATION/ RATIONALE
• MMR declined from 276 per 100,000 live births to 126 in 2022
• Still significant work to be done to improve maternal health by enhancing ANC utilization in the
country
• The peripheries of country especially District Umerkot is highly disadvantaged areas
• There may be many identified and un-identified factors hampering the ANC utilization in Umerkot
• But no any concrete scientific evidence is available till yet
• Umerkot, its people and its cultural background is quite different than other part of country
• A particular need with strong justification thus arises for this research study
• The results of this study will help the healthcare management to improve maternal health

6. RESEARCH QUESTION
• Q # 1. What are the factors which affect the utilization/ uptake of
antenatal care services by the married pregnant women in district
Umerkot?
• Q # 2. What is the magnitude of factors which affect the utilization/
uptake of antenatal care services by the married pregnant women in
district Umerkot?

7. OBJECTIVES
 To determine the frequency of utilization of antenatal care services by the married
pregnant women in district Umerkot
 To analyse the different factors influencing the utilization of antenatal care services by
the married pregnant women
 To assess the magnitude of different factors affecting the utilization of antenatal care
services by the married pregnant women
 To analyse the association of different factors with level of utilization of antenatal care
services by the married pregnant women

8. HYPOTHESES
• Null Hypothesis: Socio-demographic factors are not associated with level of
utilization of antenatal care services by the married pregnant women in district
Umerkot.
•
• Alternate Hypothesis: Socio-demographic factors are associated with level of
utilization of antenatal care services by the married pregnant women in district
Umerkot.

10. METHODOLOGY
Study Site: Community setting in the district Umerkot taking sample from all four Taluka of the district.
Study Design: Descriptive cross-sectional study
Study Duration: Six months period after the approval of the proposal
Study Population: Married women of District Umerkot who are in their reproductive age i.e. 15-49 years
Target Population: Women of reproductive age in District Umerkot.
Inclusion criteria:
 Women of age 18-49 years
 Married, living with husband
 Resident of district umerkot
 Either pregnant currently or had delivered within last one year.
Exclusion criteria:
 Pregnancy presenting as emergency case
 Women who lived in the area for less than one year
 Unmarried females, mentally retarded women

11. METHODOLOGY
• Sample Size:
• It will be calculated using WHO’s website with single proportion formula to detect the;
• P = Proportion of antenatal coverage = 60%
• Level of significance = 95%
• Margin of error = 5% (e=0.05)
• The calculated sample size is = 368 while taking a 10% (37) drop out the net sample size is
n=405.
• Sampling methodology/ technique:
• Simple random sampling with nth number technique using a list of all women who are currently
pregnant or had been pregnant in last one year. nth factor (by diving the total number in list with the sample
size). First number randomly chosen followed by nth number.
• In case of non-availability, non-response or unwillingness for the study the next number on list will be
contacted.

12. METHODOLOGY
Study variables
• Outcome
• Proportion of women who utilised/ not utilised the ANC services during pregnancy
• Proportion of factors which become the reason for utilisation/ underutilisation of ANC
• Duration and frequency of visits to Health Facility for ANC
• Independent variables
• Education, knowledge, Poverty/ income, Residence, Unemployment, Restrictions from the
Husband, Family type, Duration of marriage, Religious restrictions, time and place of last delivery
• Socio-Biological Characteristics: Age of women, husband, gestational age, parity, Comorbid (Hpt,
DM)
• Anthropometric Measurements: maternal weight and height
• Health Facility
• Type/ level of health facility, Public or private sector/ PPHI, Absenteeism, Distance, Community
visits

13. DATA COLLECTION
• Ethical approval of the study from Ethical Review Committee of the Shaheed Zulfikar Ali
Bhutto Institute of Science and Technology (SZABIST Karachi)
• Informed consent will be taken from all participants by explaining them the study purpose
• A pre-coded structured questionnaire developed in English which then will be translated into
local language i.e. Sindhi (Pre testing of the questionnaire will be done on 40 women (10% of
the total sample)
• LHVs will be hired and trained on data collection after getting the list of eligible women
finalized
• The principal Investigator will continuously monitor/ troubleshoot the process of data
collection
• Results will be submitted to SZABIST Karachi & Health Dept. authorities
• Publications of the research into a reputed Science Journal

14. DATA ANALYSIS
• Data Entry and analysis will be done using Statistical Package for Social Sciences (SPSS) version
24
• Mean and standard deviation will be obtained for continuous variable like (age of women,
gestational age, income, parity, distance to HF, antenatal visits paid
• Frequencies like (Proportion of antenatal care services utilisation, proportion of affecting factors,
visit to HF for ANC, residence, education, unemployment
• Bivariate analysis will be expressed to analyse the associations of Proportion of ANC utilisation
with the affecting factors. For this purpose, chi-square & students’ t-test will be used
• P-values will also be calculated by Likelihood ratio test for the significance
• Logistic regression will be used to identify the factors associated with the outcome variables

15. DUMMY TABLES
variable
Minim
um
Mean (± SD)
Maximu
m
Age of the Patient 18 29.52 ± 6.17 40
Number of children 0 1.71 ± 1.11 4
Gestational age 21 30.39 ± 4.90 38
Gravida 1 2.87 ± 1.15 5
Duration of Marriage
Distance from HF
Family monthly
Income
Antenatal visits paid
Table: 2. Antenatal Coverage
Use of
ANC
services
Non-use
of ANC
services
Total
Distance
to
Health
facility
< 5 Kms 112 80 192
> 5 Kms 46 104 150
Total 158 184 342

16. BUDGET
Sr. # Item/ Supplies/ cost Unit cost Multiplier Total cost
A SUPPLIES
1 Printing of questionnaires Rs. 30 per form 425 12,750
2
Transportation for 30 trips of four
persons
Rs. 300/ person/day
= Rs. 1200/day
30 36,000
3 Training of data collectors Rs. 2500 per person 4 10,000
4
Supplies/ telephone calls/
mobile package etc.
20,000 Lumpsum 20,000
5 Computers/ typing/ Software etc 50,000 Lumpsum 50,000
6
Publication and dissemination of
results
50,000 Lumpsum 50,000
B PERSONNEL
7 4 LHVs Each @ Rs. 10,000 per month
Three
months
1,20,000
8 Data entry operators @ RS. 50 per form 405 20,250
9 Other Miscellaneous/ Unforeseen 20,000 Lumpsum 20,000
Grand Total 3,39,000/-

17. GANTT
CHART/
ACTIVITY
SCHEDULE
Sr. # Activity
Time in weeks
2 4 6 8 10 12 14 16 18 20 22 24
1
Submission of Proposal to ERC,
SZABIST
2
Revision and
Approval of Proposal
3
Recruitment and Training of
Data collectors
4
Data Collection, cleaning,
Sorting
5 Data Entry and Analysis
6
Presentation of first draft of
Results till Final draft
7
Submission of Research
findings to ERC

18. CONSENT FORM
My name is DR. MONIKA MAHESHWARI and I have come from Shaheed Zulfikar Ali Bhutto Institute of Science and Technology,
(SZABIST) Karachi. We are doing research to observe the “Factors affecting the utilization of antenatal care services by the pregnant
women in District Umerkot”
The purpose of this research is to assess the magnitude of antenatal care utilization and to understand and highlight its core responsible factors
among women of reproductive age in district Umerkot. For this reason, this interview is being done. This information that you will share with us
will be helpful in the maternal health. You have fill or reply us to fill this form once.
All information that you will share with us will be kept confidential, and will not be revealed to anyone. If you have any queries you can ask
without hesitation.
No compensation/ remuneration for your participation will be offered and your participation is wholly voluntary.
Even after signing the consent form, you can refuse to participate in the study. Even if you start the study, you can still withdraw at any time
without any penalty.
This questionnaire will take approximately 30 minutes of your time. If you have read and understood this consent form, and volunteer to
participate in this research study then please sign below.
Participant Name and Signature:
Date:
Principal Investigator Signature:
Date:
Signature of Person Obtaining Consent:
Date:

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21. THANKING YOU FOR PATIENCE LISTENING
The forum is open for debate